Provider Demographics
NPI:1851771711
Name:KILLEBREW, KACEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KACEY
Middle Name:
Last Name:KILLEBREW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 COUNTY ROAD 620
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8686
Mailing Address - Country:US
Mailing Address - Phone:870-680-2924
Mailing Address - Fax:
Practice Address - Street 1:214 W DREW AVE
Practice Address - Street 2:
Practice Address - City:MONETTE
Practice Address - State:AR
Practice Address - Zip Code:72447-9010
Practice Address - Country:US
Practice Address - Phone:870-486-2111
Practice Address - Fax:870-486-2565
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist